April 1st, 2020

I’m hearing the familiar sounds of pushing start. It’s what many of us describe as “grunty”; this sort of edge to the vocalizations she’s been making for many hours. When I was a homebirth midwifery assistant, we would all get real excited hearing that. I’m excited now, because my 200th baby is on the way. I’d been talking about this baby for months, knowing that in this 13th year of my work as a doula, I would see this milestone birth. I knew I would always remember it like I remember my first and my hundredth but I’ll remember this one even more significantly. Because I’m not really in the room.

I’m watching this birth and listening to these telltale sounds through my client’s husband’s phone. I’m a “Virtual” Doula this time because of coronavirus. And it’s breaking my heart.

We had a consultation set up the same day that our state went into emergency. While this client was at her OB appointment, just hours before that consult, policy changes came down. Instead of multiple support people or visitors, they were now limiting labor and delivery clients to one. This hospital, like others in the city, decided that a doula was a visitor, therefore… pick your partner or pick your doula.

Parting with this sweet couple before I even met them in-person was heart-wrenching. They really ‘got it’ about what we do and the value of our support. Now they weren’t going to be able to benefit from that.

It gnawed at me for days. While I do understand the desire and need to flatten the curve and slow this virus, doulas aren’t visitors. We are a part of a family’s chosen healthcare team. The presence of a doula benefiting positive and health birth outcomes is proven in 27 studies now. We have immense value.

I continued to call hospitals, talk to other birth workers, participated in nation-wide calls with organizations scurrying to get in front of this issue all while thinking of my spring and summer time clients, wondering how I was going to support them. I spent the weekend in mourning after learning that facility after facility was shutting us out.

Come Monday morning, I started my calls again and learned that the IU and Community Health systems had adjusted their policies, and professional doulas were back in the game. However, I still had clients birthing in other places. What about them? And there was still that couple I couldn’t get out of my mind who was going into their first birth without the support they wanted.

For those clients and that couple, I had a thought late at night. It was a term I never really got down with before – Virtual Doula. Typically, I call doula support educational, emotional and physical. How can we really do that job if we aren’t there physically? If we can’t help position the laboring person, or give a light touch massage, or do the popular (and really helpful) hip squeeze or even use my Rebozo? I once had a midwife say, 5 minutes after I entered a room, “It’s the Tamrha effect” because mama calmed down so much once I arrived. How can I apply the “Tamrha effect” or any other doula apply her calming effect, if we are not there?

Then I thought about the conversations I’ve had with laboring moms over the phone before it was time to go, as well as the conversations with their partners. I thought about the importance of the education provided in the months and weeks before their births and the importance of their knowing that our connection still exists for anything that might come up postpartum. I considered all the times I’ve had clients who’ve gone in for inductions and how I like to hang back, letting things get rolling without my being in the room as to not cause the family to think they have to care for or ‘entertain me’. That way they’ll progress faster.

I even thought about friends and family I’ve supported from a distance, ones who live states away. I thought of one of my very first clients who birthed unexpected in her living room, only having me in the phone (actually I was on two phones because on the other I had 911). Guiding her husband through that catch is something I won’t forget.

I told myself to see the benefits in those situations and I said out loud, “Doulas roll with the unexpected.”

Talk about the unexpected in all that’s going on now.

So, I adjusted my thinking. We are going virtual for clients for all consultations and prenatal visits, because that’s simply the responsible thing to do (that part wasn’t even a question and we are having fun doing it). For current clients who I cannot support in-person unless the policies at their places of birth change in time, or any client who wants the distance, I’ll go virtual. I see now that it’s possible and it’s valuable and it’s important.

I went back to that sweet couple and offered up the idea. They discussed it and came back to me with a big yes! As babies do (and especially Aries babies who are head strong and do what they want when they want it and I would know because mine is turning 15 today), this baby didn’t give us time for a virtual prenatal. 199 births and it’s happened that I’ve met a client on a Friday and had a baby the day before their scheduled Monday prenatal visit! Mom and dad were well read and as prepared as they could be, and so…we went for it.

And now we are pushing…for the second time.

This was a long-ish birth but it’s not a pattern I haven’t seen before. We started out like any other labor – mom texting me, keeping up communication until it becomes a text or call of, ‘Hi. It’s (insert husband/boyfriend/partner name). I’ve got her phone…’ As I always say, BING! We have just ratcheted up to active labor!

I stay in text contact with the partner until it’s time for me to leave, but this time there was no leaving my house. This time, we turned to Skype. Thank goodness for Skype.

It’s always precious to be face to face with a woman in labor, but this time it was ‘extra’. Her sweet and yet very tired smile, is something I’ll never forget. If only I could have wiped her tears in her vulnerable moments like I always do, however I teach Active Listening for a reason. Active Listening was the only tissue I had.

I also still had my voice, my knowledge of birth, skills to guide dad through and it worked. When I suggested a change in position, they did it. When I described something that might have been going on, they learned things and were able to make informed choices. When I suggested the shower or the peanut ball or sacral pressure, they used it. They were amazing!

It was important to me that when pushing started (again) that Dad be focused on his wife and coming baby, whose sex was still a mystery. Holding the phone so I could see was not what I wanted them to do. So, dad propped his phone up in a corner which was a perfect spot actually and I could see the whole room. More importantly, mama later told me that she could look over and see me.

And then, in 20 pushes… she was born. I have not cried like that at a birth in a really long time.

This job is a calling. It’s beautiful and difficult, rewarding and taxing. It has taught me so much and has allowed me to be present as families grow and love blooms. It has brought me through the path of life and death as well, and I’m grateful. This virus and the struggles it has brought down on the world, including the world of birth, are arduous. It’s challenging us in ways we didn’t expect and testing our resiliency. However, like I said above, doulas roll with the unexpected as do birthing families and nurses and doctors everywhere.

In our virtual postpartum visit, this beamingly happy couple expressed their gratitude and satisfaction with my virtual presence. I’m hoping that they’ll find some time in their early postpartum days to write a bit about that, but until then I’ll tell you one thing they told me that brought tears to my eyes again:

“We’ve told everyone how great this was! It wouldn’t have gone the same without you there.”

Without me there. I was there, wasn’t I?

Happy Birthday #200, my first “official” virtual baby born on my son’s 15th birthday, who taught me to think outside the box and keep serving families no matter what the world throws at me. May you be blessed.